title: Peroral video cholangioscopy to evaluate indeterminate bile duct lesions and preoperative mucosal cancerous extension: a prospective multicenter study.
abstract: OBJECTIVE
  Despite the development of peroral video cholangioscopy (PVCS), no prospective multicenter studies have been undertaken to investigate the diagnostic accuracy of PVCS in biliary tract diseases. Therefore, the aim of this study was to clarify the accuracy of PVCS in evaluating biliary tract lesions.
  
  
  METHODS
  This study was a prospective multicenter study at five tertiary referral centers in Japan and included 87 eligible patients with biliary tract diseases who underwent PVCS. The study evaluated the ability of PVCS to diagnose indeterminate biliary tract diseases, detect mucosal cancerous extension preoperatively in extrahepatic bile duct cancers, and predict adverse events.
  
  
  RESULTS
  The use of PVCS appearance alone correctly distinguished benign from malignant indeterminate biliary lesions in 92.1 % of patients whereas biopsy alone was accurate in 85.7 %. In extrahepatic bile duct cancer, mucosal cancer extended histologically at least 20 mm in 34.7 % (17/49) of patients. The accuracy rate of PVCS to evaluate the presence or absence of mucosal cancerous extension by endoscopic retrograde cholangiography (ERC) alone, ERC with PVCS, and ERC with PVCS + biopsy were 73.5 %, 83.7 %, and 92.9 %, respectively. Adverse events were seen in 6.9 % of PVCS patients, but no serious complications were observed.
  
  
  CONCLUSIONS
  PVCS enhanced the accurate diagnosis of biliary tract lesions by providing excellent resolution in combination with biopsy.
authors.affiliation: Center for Gastroenterology Teine Keijinkai Hospital, Sapporo, Hokkaido 006-8555, Japan. m-osanai@tkeijinkai.gr.jp
authors.forename: M
authors.initials: M
authors.lastname: Osanai
authors.forename: T
authors.initials: T
authors.lastname: Itoi
authors.forename: Y
authors.initials: Y
authors.lastname: Igarashi
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: M
authors.initials: M
authors.lastname: Kida
authors.forename: H
authors.initials: H
authors.lastname: Maguchi
authors.forename: K
authors.initials: K
authors.lastname: Yasuda
authors.forename: N
authors.initials: N
authors.lastname: Okano
authors.forename: H
authors.initials: H
authors.lastname: Imaizumi
authors.forename: F
authors.initials: F
authors.lastname: Itokawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000473:pathology* / Q000601:surgery; D001706:Biopsy; D002761:Cholangitis / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D009361:Neoplasm Invasiveness; D016577:Pancreaticoduodenectomy; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult